General Question for the Week of March 20, 2017

General Compliance Question of the Week

Question:

What is the purpose of the Medicare CERT program?

Answer:

The Comprehensive Error Rate Testing (CERT) Program estimates improper payments in the Medicare fee-for-service (FFS) program. CERT reviewers evaluate a random sample of all Medicare FFS claims to determine if they met Medicare coverage, coding, and billing rules. Once the CERT Program identifies a claim as part of the sample, it requests the associated medical records and other pertinent documentation from the provider or supplier who submitted the claim. Medical review professionals check the submitted documentation to see if the claim was paid or denied appropriately.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.